Health Cabinet Secretary (CS) Aden Duale has announced the formation of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims.
In a gazette notice on March 28, Duale said the committee, chaired by James Masiro Ojee and consisting of eighteen other members, will scrutinize all pending claims accumulated between July 1, 2022, and September 30, 2024.
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Duale said the Committee will establish a clear framework to determine the validity of the claims and make recommendations to the Ministry of Health on settlement.
The Committee will be domiciled at the Social Health Authority (SHA) building and serve for a period of three months, effective March 28
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It will establish clearly defined criteria for detailed examination and analysis of such pending medical claims with a view determining the genuineness of each.
He explained that the Committee will make recommendations on the settlement of genuine claims while identifying and flagging any fraudulent or irregular submissions for appropriate action.
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“Identify any cases where they may have been corrupted, fraudulent and false medical claims and make appropriate recommendations to the relevant Government agencies,” reads part of the mandate of the Committee.
Duale Lists Other Functions of the Committee
Additionally, the committee will propose long-term reforms to prevent future claim backlogs, ensuring a transparent, accountable and efficient claims process.
It will also perform any other function incidental to the foregoing.
The Committee shall have access to any previous reports relevant to its mandate.
It will regulate its own procedures with respect to the orderly conduct of its proceedings, quorum for the transaction of business and other related matters.
Besides, the Committee will carry out or cause to be carried out such studies or research as is necessary in furtherance of its mandate.
Duale stated that the Chairperson and other members of the Committee shall subscribe to the Declaration set out in the Schedule prior to embarking on their duties.
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Members
The Committee comprises James Masiro Ojee as Chairperson, and Anne Wamae (Dr.) Vice Chairperson,
Members include Edward Kiplimo Bitok, Meshack Matengo, Meboh Atieno Awour, Tom Nyakaba, Catherine Karori Bosire, Paul Wafula, Catherine Mungunia, James Oundo, Jackline Mukami Njiru, Judith Awinja and David Dawe.
Also Read: SHA Clarifies Paying Ruto’s Home Hospital Ksh345 Million
Committee Secretariat & Roles
The Committee has a Secretariat consisting of Peter Kitheka (Head of the Secretariat,) Shawn Mogaka, Dr. Consolata Ogot, Dr. Emmanuel Ayodi Lusigi, Halima Yussuf and Wilbert Kurgat.
The Secretariat of the Committee will perform the following function.
- Accurately capturing the deliberation of the Committee.
- Keeping the records of the Committee.
- Preparing the Committee’s reports and disseminating any information deemed relevant by the Committee
- Undertaking research and liaising with relevant Government agencies, departments and any other institution for the purposes of collecting relevant information necessary in furtherance of the Committee’s mandate.
- Any other responsibility as assigned by the Committee.
Ruto Directives on NHIF Claims
On March 5, President William Ruto said the government will fully pay all health facilities with claims of Ksh10 million and below contracted by NHIF.
Ruto said the claims affecting public, faith-based and private hospitals equate to 91 percent of the total facilities under NHIF.
He also directed the Health Ministry to establish a verification committee to scrutinize hospitals with claims above Ksh10 million.
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